Standards Care Limited

Standards Care Limited is a domiciliary care service providing personal care to people in their own homes. The service provides support to people with physical disabilities, mental health or learning disabilities who need support with everyday activities. At the time of our inspection there were three people using the service.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Though some improvements had been made, significant issues remained in assessing and managing risks to people’s health, safety and wellbeing. Medicines were not managed safely. Recruitment procedures were not robust to ensure staff were appropriate to work with people. Some incidents were reported and investigated robustly, this appeared to have improved.

People were not always supported to have maximum choice and control of their lives and the provider did not ensure staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Best practice and expected standards were not always followed in assessing and planning to meet people’s needs. Risks related to people’s eating and drinking were not always assessed, though people’s relatives told us that people were supported to eat and drink enough.

People’s relatives told us that, though there had been unkind staff in the past, the current staff caring for their loved ones were professional and compassionate. Staff we spoke with were passionate about their work and clearly cared for people.

Improvements had been made in managing complaints, which had been an issue on the previous inspection. Staff we spoke with knew people well and understood their preferences, religious and spiritual needs.

Though we had positive feedback about improvements in the change in management, there remained significant issues with the service which had not been resolved since the last inspection. The new manager has created a quality improvement plan after the inspection, and has sent evidence of actions taken after the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 March 2021). The service remains rated requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. Complete/delete as appropriate. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment; need for consent; staffing; fit and proper persons employed and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Standards Care Limited is a domiciliary care service providing personal care for people in their own homes. At the time of the inspection there were eight people receiving the regulated activity.

Not everyone who would use the service would receive personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

We were not assured the provider was assessing and managing risks to people’s health, safety and wellbeing effectively. Risks to people were not always assessed and there were not always clear measures in place to manage identified risks. Staff did not have a good understanding of safeguarding people from abuse. Medicines were not managed safely.

The service had adequate measures to manage risks related to infection, including from Covid-19. Incidents were reported; however, it was not always clear what actions were taken to reduce the risk of similar incidents re-occurring.

The service had not always applied best practice or national standards when planning and delivering care. We were not assured appropriate medical advice was always sought, and that professional guidance was available to staff when supporting people.

Though there were adequate policies and procedures in place, people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and following the requirements of the Mental Capacity Act (MCA). Staff did not always have a good understanding of the application of the MCA.

People’s individual eating and drinking needs and risks related to choking or malnutrition were not fully assessed and planned for safely.

Feedback about care staff approach was mixed, some people and their relatives told us staff were kind and caring, whilst others said it varied between staff. People and their relatives told us they could not always communicate their wishes to staff due to a language barrier.

There were some good examples of people being supported with activities they enjoyed, which promoted their wellbeing. Where there was good continuity of care with a long-standing care worker, they knew people well. However, some people did not have the same carer workers routinely and their care plans did not contain information on their preferences or reflect their individual needs.

The provider had previously identified some of the issues found at this inspection and had started to resolve them. However, we were not assured the provider’s quality and assurance measures were sufficient to identify and quickly resolve quality and safety issues. Records were not always complete or accurate.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 12 July 2018 and this is the first inspection.

Why we inspected

The inspection was prompted in part due the time since the service had registered and concerns the Care Quality Commission (CQC) had received. These included concerns about; the skill, competency and approach of care staff, communication skills and language barriers with care staff, risk management, managing medicines and management oversight of the quality of the service.

A decision was made for us to inspect and examine those risks. As the service had not been previously inspected, it was deemed in the public interest for us to review all key lines of enquiry (KLOEs) in order to rate the service.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment; consent; staffing; fit and proper persons employed; managing complaints and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.